- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,230.27 / $7,943.28
| Facility | | $676.08 | $1,230.27 | $7,943.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.74 / $1,047.13 / $1,288.25
| Professional | | $467.74 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $954.99 / $1,445.44
| Facility | | $676.08 | $954.99 | $1,445.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.58 / $977.24 / $1,023.29
| Facility | | $758.58 | $977.24 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $776.25 / $1,258.93
| Facility | | $575.44 | $776.25 | $1,258.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,691.53 / $2,691.53 / $2,691.53
| Facility | | $2,691.53 | $2,691.53 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,454.71 / $10,232.93 / $37,153.52
| Facility | | $2,454.71 | $10,232.93 | $37,153.52 |